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A comprehensive overview of important and contested issues in vaccination ethics and policy by experts from history, science, policy, law, and ethics.

Vaccination has long been a familiar, highly effective form of medicine and a triumph of public health. Because vaccination is both an individual medical intervention and a central component of public health efforts, it raises a distinct set of legal and ethical issues—from debates over their risks and benefits to the use of government vaccination requirements—and makes vaccine policymaking uniquely challenging. This volume examines the full range of ethical and policy issues related to the development and use of vaccines in the United States and around the world. Forty essays, articles, and reports by experts in the field look at all aspects of the vaccine life cycle. After an overview of vaccine history, they consider research and development, regulation and safety, vaccination promotion and requirements, pandemics and bioterrorism, and the frontier of vaccination.

The texts cover such topics as vaccine safety controversies; the ethics of vaccine trials; vaccine injury compensation; vaccine refusal and the risks of vaccine-preventable diseases; equitable access to vaccines in emergencies; lessons from the eradication of smallpox; and possible future vaccines against cancer, malaria, and Ebola.

The volume intentionally includes texts that take opposing viewpoints, offering readers a range of arguments. The book will be an essential reference for professionals, scholars, and students.

This book discusses some of the most critical ethical issues in mental health care today, including the moral dimensions of addiction, patient autonomy and compulsory treatment, privacy and confidentiality, and the definition of mental illness itself. Although debates over these issues are ongoing, there are few comprehensive resources for addressing such dilemmas in the practice of psychology, psychiatry, social work, and other behavioral and mental health care professions. This book meets that need, providing foundational background for undergraduate, graduate, and professional courses.

Topics include central questions such as evolving views of the morality and pathology of deviant behavior; patient competence and the decision to refuse treatment; recognizing and treating people who have suffered trauma; addiction as illness; the therapist's responsibility to report dangerousness despite patient confidentiality; and boundaries for the therapist's interaction with patients outside of therapy, whether in the form of tennis games, gift-giving, or social media contact. For the most part the selections address contemporary issues in contemporary terms, but the book also offers a few historic or classic essays, including Thomas S. Szasz's controversial 1971 article “The Ethics of Addiction.”

Contributor

An examination of the ethical issues raised by the possibility of human life extension, including its desirability, unequal access, and the threat of overpopulation.

Life extension—slowing or halting human aging—is now being taken seriously by many scientists. Although no techniques to slow human aging yet exist, researchers have successfully slowed aging in yeast, mice, and fruit flies, and have determined that humans share aging-related genes with these species. In New Methuselahs, John Davis offers a philosophical discussion of the ethical issues raised by the possibility of human life extension. Why consider these issues now, before human life extension is a reality? Davis points out that, even today, we are making policy and funding decisions about human life extension research that have ethical implications. With New Methuselahs, he provides a comprehensive guide to these issues, offering policy recommendations and a qualified defense of life extension.

After an overview of the ethics and science of life extension, Davis considers such issues as the desirability of extended life; whether refusing extended life is a form of suicide; the Malthusian threat of overpopulation; equal access to life extension; and life extension and the right against harm. In the end, Davis sides neither with those who argue that there are no moral objections to life enhancement nor with those who argue that the moral objections are so strong that we should never develop it. Davis argues that life extension is, on balance, a good thing and that we should fund life extension research aggressively, and he proposes a feasible and just policy for preventing an overpopulation crisis.

How developing a more expansive, non-formal conception of reason produces richer ethical understandings of human situations, explored and illustrated with many real examples.

In Re-Reasoning Ethics, Barry Hoffmaster and Cliff Hooker enhance and empower ethics by adopting a non-formal paradigm of rational deliberation as intelligent problem-solving and a complementary non-formal paradigm of ethical deliberation as problem-solving design to promote human flourishing. The non-formal conception of reason produces broader and richer ethical understandings of human situations, not the simple, constrained depictions provided by moral theories and their logical applications in medical ethics and bioethics. Instead, it delivers and vindicates the moral judgment that complex, contextual, and dynamic situations require.

Hoffmaster and Hooker demonstrate how this more expansive rationality operates with examples, first in science and then in ethics. Non-formal reason brings rationality not just to the empirical world of science but also to the empirical realities of human lives. Among the many real cases they present is that of how women at risk of having children with genetic conditions decide whether to try to become pregnant. These women do not apply the formal principle of maximizing expected utility (as advised by genetic counselors) and instead imagine scenarios of what their lives could be like with an affected child and assess whether they could accept the worst of these scenarios.

Hoffmaster and Hooker explain how moral compromise and a liberated, extended, and enriched reflective equilibrium expand and augment rational ethical deliberation and how that deliberation can rationally design ethical practices, institutions, and policies.

An argument that more people should have children with Down syndrome, written from a pro-choice, disability-positive perspective.

The rate at which parents choose to terminate a pregnancy when prenatal tests indicate that the fetus has Down syndrome is between 60 and 90 percent. In Choosing Down Syndrome, Chris Kaposy offers a carefully reasoned ethical argument in favor of choosing to have such a child. Arguing from a pro-choice, disability-positive perspective, Kaposy makes the case that there is a common social bias against cognitive disability that influences decisions about prenatal testing and terminating pregnancies, and that more people should resist this bias by having children with Down syndrome.

Drawing on accounts by parents of children with Down syndrome, and arguing for their objectivity, Kaposy finds that these parents see themselves and their families as having benefitted from having a child with Down syndrome. To counter those who might characterize these accounts as based on self-deception or expressing adaptive preference, Kaposy cites supporting evidence, including divorce rates and observational studies showing that families including children with Down syndrome typically function well. Himself the father of a child with Down syndrome, Kaposy argues that cognitive disability associated with Down syndrome does not lead to diminished well-being. He argues further that parental expectations are influenced by neoliberal ideologies that unduly focus on the supposed diminished economic potential of a person with Down syndrome.

Kaposy does not advocate restricting access to abortion or prenatal testing for Down syndrome, and he does not argue that it is ethically mandatory in all cases to give birth to a child with Down syndrome. People should be free to make important decisions based on their values. Kaposy's argument shows that it may be consistent with their values to welcome a child with Down syndrome into the family.

How medical education and practice can move beyond a narrow focus on biological intervention to recognize the lived experiences of illness, suffering, and death.

In Afflicted, Nicole Piemonte examines the preoccupation in medicine with cure over care, arguing that the traditional focus on biological intervention keeps medicine from addressing the complex realities of patient suffering. Although many have pointed to the lack of compassion and empathy in medical practice, few have considered the deeper philosophical, psychological, and ontological reasons for it. Piemonte fills that gap, examining why it is that clinicians and medical trainees largely evade issues of vulnerability and mortality and, doing so, offer patients compromised care. She argues that contemporary medical pedagogy and epistemology are not only shaped by the human tendency to flee from the reality of death and suffering but also perpetuate it. The root of the problem, she writes, is the educational and institutional culture that promotes reductionist understandings of care, illness, and suffering but avoids any authentic confrontation with human suffering and the fear and self-doubt that can come with that confrontation. Through a philosophical analysis of the patient-practitioner encounter, Piemonte argues that the doctor, in escaping from authentic engagement with a patient who is suffering, in fact “escapes from herself.”

Piemonte explores the epistemology and pedagogy of medicine, examines its focus on calculative or technical thinking, and considers how “clinical detachment” diminishes physicians. She suggests ways that educators might cultivate the capacity for authentic patient care and proposes specific curricular changes to help students expand their moral imaginations.

An exploration of moral stress, distress, and injuries inherent in modern society through the maps that pervade academic and public communications worlds.

In Ethics in Everyday Places, ethicist and geographer Tom Koch considers what happens when, as he puts it, “you do everything right but know you've done something wrong." The resulting moral stress and injury, he argues, are pervasive in modern Western society. Koch makes his argument "from the ground up," from the perspective of average persons, and through a revealing series of maps in which issues of ethics and morality are embedded.

The book begins with a general grounding in both moral stress and mapping as a means of investigation. The author then examines the ethical dilemmas of mapmakers and others in the popular media and the sciences, including graphic artists, journalists, researchers, and social scientists. Koch expands from the particular to the general, from mapmaker and journalist to the readers of maps and news. He explores the moral stress and injury in educational funding, poverty, and income inequality ("Why aren't we angry that one in eight fellow citizens lives in federally certified poverty?"), transportation modeling (seen in the iconic map of the London transit system and the hidden realities of exclusion), and U.S. graft organ transplantation.

This uniquely interdisciplinary work rewrites our understanding of the nature of moral stress, distress and injury, and ethics in modern life. Written accessibly and engagingly, it transforms how we think of ethics—personal and professional—amid the often conflicting moral injunctions across modern society.

Legal, regulatory, and ethical perspectives on balancing social benefit and human autonomy in research using human biospecimens.

Advances in medicine often depend on the effective collection, storage, research use, and sharing of human biological specimens and associated data. But what about the sources of such specimens? When a blood specimen is drawn from a vein in your arm, is that specimen still you? Is it your property, intellectual or otherwise? Should you be allowed not only to consent to its use in research but also to specify under what circumstances it may be used? These and other questions are at the center of a vigorous debate over the use of human biospecimens in research. In this book, experts offer legal, regulatory, and ethical perspectives on balancing social benefit and human autonomy in biospecimen research.

After discussing the background to current debates as well as several influential cases, including that of Henrietta Lacks, the contributors consider the rights, obligations, risks, and privacy of the specimen source; different types of informed consent under consideration (broad, blanket, and specific); implications for special patient and researcher communities; and the governance of biospecimen repositories and the responsibilities of investigators.

Interdisciplinary perspectives on the science, politics, and ethics of the 2013–2015 Ebola virus disease outbreak.

The 2013–2015 outbreak of the Ebola virus disease (EVD) was a public health disaster: 28,575 infections and 11,313 deaths (as of October 2015), devastating the countries of Guinea, Liberia, and Sierra Leone; a slow and mismanaged international response; and sensationalistic media coverage, seized upon by politicians to justify wrongheaded policy. And yet there were also promising developments that may improve future responses to infectious disease epidemics: the UN Security Council's first involvement in a public health event; a series of promising clinical treatments and vaccines for EVD; and recognition of the need for a global public health system to deal with epidemics that cross national borders. This volume offers a range of perspectives on these and other lessons learned, with essays on the science, politics, and ethics of the Ebola outbreak.

The contributors discuss topics including the virology and management of EVD in both rich and poor nations; the spread of the disease (with an essay by a leader of Médecins Sans Frontières); racist perceptions of West Africa; mainstream and social media responses to Ebola; and the ethical issue of whether to run clinical trials of experimental treatments during an outbreak.

An argument that moral functioning is immeasurably complex, mediated by biology but not determined by it.

Throughout history, humanity has been seen as being in need of improvement, most pressingly in need of moral improvement. Today, in what has been called the beginnings of “the golden age of neuroscience,” laboratory findings claim to offer insights into how the brain “does” morality, even suggesting that it is possible to make people more moral by manipulating their biology. Can “moral bioenhancement”—using technological or pharmaceutical means to boost the morally desirable and remove the morally problematic—bring about a morally improved humanity? In The Myth of the Moral Brain, Harris Wiseman argues that moral functioning is immeasurably complex, mediated by biology but not determined by it. Morality cannot be engineered; there is no such thing as a “moral brain.”

Wiseman takes a distinctively interdisciplinary approach, drawing on insights from philosophy, biology, theology, and clinical psychology. He considers philosophical rationales for moral enhancement, and the practical realities they come up against; recent empirical work, including studies of the cognitive and behavioral effects of oxytocin, serotonin, and dopamine; and traditional moral education, in particular the influence of religious thought, belief, and practice. Arguing that morality involves many interacting elements, Wiseman proposes an integrated bio-psycho-social approach to the consideration of moral enhancement. Such an approach would show that, by virtue of their sheer numbers, social and environmental factors are more important in shaping moral functioning than the neurobiological factors with which they are interwoven.

Why preterm birth rates in the United States remain high even as access to prenatal care has improved and infant mortality has steadily dropped.

The United States has one of the highest rates of premature birth of any industrialized nation: 11.5%, nearly twice the rate of many European countries. In this book, John Lantos and Diane Lauderdale examine why the rate of preterm birth in the United States remains high—even though more women have access to prenatal care now than three decades ago. They also analyze a puzzling paradox: why, even as the rate of preterm birth rose through the 1990s and early 2000s, the rate of infant mortality steadily decreased.

Lantos and Lauderdale explore both the medical practices that might give rise to these trends as well as some of the demographic changes that have occurred over these years. American women now delay childbearing, for example, and have fewer babies. Doctors are better able to monitor fetal health and well-being. Prenatal care has changed, no longer focusing solely on the health of the pregnant woman. Today, the fetus has become a patient, and many preterm births are medically induced because of concern for the well-being of the fetus. Preterm birth is no longer synonymous with a bad outcome. Sometimes, it is necessary for a good one.

Physicians, philosophers, and theologians consider how to address death and dying for a diverse population in a secularized century.

Most of us are generally ill-equipped for dying. Today, we neither see death nor prepare for it. But this has not always been the case. In the early fifteenth century, the Roman Catholic Church published the Ars moriendi texts, which established prayers and practices for an art of dying. In the twenty-first century, physicians rely on procedures and protocols for the efficient management of hospitalized patients. How can we recapture an art of dying that can facilitate our dying well? In this book, physicians, philosophers, and theologians attempt to articulate a bioethical framework for dying well in a secularized, diverse society.

Contributors discuss such topics as the acceptance of human finitude; the role of hospice and palliative medicine; spiritual preparation for death; and the relationship between community, and individual autonomy. They also consider special cases, including children, elderly patients with dementia, and death in the early years of the AIDS epidemic, when doctors could do little more than accompany their patients in humble solidarity.

These chapters make the case for a robust bioethics—one that could foster both the contemplation of finitude and the cultivation of community that would be necessary for a contemporary art of dying well.

An argument that the system of boards that license human-subject research is so fundamentally misconceived that it inevitably does more harm than good.

Medical and social progress depend on research with human subjects. When that research is done in institutions getting federal money, it is regulated (often minutely) by federally required and supervised bureaucracies called “institutional review boards” (IRBs). Do—can—these IRBs do more harm than good? In The Censor's Hand, Schneider addresses this crucial but long-unasked question.

Schneider answers the question by consulting a critical but ignored experience—the law's learning about regulation—and by amassing empirical evidence that is scattered around many literatures. He concludes that IRBs were fundamentally misconceived. Their usefulness to human subjects is doubtful, but they clearly delay, distort, and deter research that can save people's lives, soothe their suffering, and enhance their welfare. IRBs demonstrably make decisions poorly. They cannot be expected to make decisions well, for they lack the expertise, ethical principles, legal rules, effective procedures, and accountability essential to good regulation. And IRBs are censors in the place censorship is most damaging—universities.

In sum, Schneider argues that IRBs are bad regulation that inescapably do more harm than good. They were an irreparable mistake that should be abandoned so that research can be conducted properly and regulated sensibly.

Experts from different disciplines offer novel ideas for improving research oversight and protection of human subjects.

The current framework for the regulation of human subjects research emerged largely in reaction to the horrors of Nazi human experimentation, revealed at the Nuremburg trials, and the Tuskegee syphilis study, conducted by U.S. government researchers from 1932 to 1972. This framework, combining elements of paternalism with efforts to preserve individual autonomy, has remained fundamentally unchanged for decades. Yet, as this book documents, it has significant flaws—including its potential to burden important research, overprotect some subjects and inadequately protect others, generate inconsistent results, and lag behind developments in how research is conducted. Invigorated by the U.S. government's first steps toward change in over twenty years, Human Subjects Research Regulation brings together the leading thinkers in this field from ethics, law, medicine, and public policy to discuss how to make the system better. The result is a collection of novel ideas—some incremental, some radical—for the future of research oversight and human subject protection.

After reviewing the history of U.S. research regulations, the contributors consider such topics as risk-based regulation; research involving vulnerable populations (including military personnel, children, and prisoners); the relationships among subjects, investigators, sponsors, and institutional review boards; privacy, especially regarding biospecimens and tissue banking; and the possibility of fundamental paradigm shifts.

A provocative argument that the best way to deliver high-quality healthcare to Americans is to institute a comprehensive and fair system of rationing.

Most people would agree that the healthcare system in the United States is a mess. Healthcare accounts for a larger percentage of gross domestic product in the United States than in any other industrialized nation, but health outcomes do not reflect this enormous investment. In this book, Philip Rosoff offers a provocative proposal for providing quality healthcare to all Americans and controlling the out-of-control costs that threaten the economy. He argues that rationing—often associated in the public's mind with such negatives as unplugging ventilators, death panels, and socialized medicine—is not a dirty word. A comprehensive, centralized, and fair system of rationing is the best way to distribute the benefits of modern medicine equitably while achieving significant cost savings.

Rosoff points out that certain forms of rationing already exist when resources are scarce and demand high: the organ transplant system, for example, and the distribution of drugs during a shortage. He argues that if we incorporate certain key features from these systems, healthcare rationing would be fair—and acceptable politically. Rosoff considers such topics as fairness, decisions about which benefits should be subject to rationing, and whether to compensate those who are denied scarce resources. Finally, he offers a detailed discussion of what an effective and equitable healthcare rationing system would look like.

An argument that French adoption policies reflect and enforce the state's notions of gender, parenthood, and citizenship.

In May 2013, after months of controversy, France legalized same-sex marriage and adoption by homosexual couples. Obstacles to adoption and parenting equality remain, however—many of them in the form of cultural and political norms reflected and expressed in French adoption policies. In The Politics of Adoption, Bruno Perreau describes the evolution of these policies. In the past thirty years, Perreau explains, political and intellectual life in France have been dominated by debates over how to preserve “Frenchness,” and these debates have driven policy making. Adoption policies, he argues, link adoption to citizenship, reflecting and enforcing the postcolonial state's notions of parenthood, gender, and Frenchness.

After reviewing the complex history of adoption, Perreau examines French political debates over adoption, noting, among other things, that intercountry adoptions stirred far less controversy than the difference between the sexes in an adopting couple. He also discusses judicial action on adoption; child welfare agencies as gatekeepers to parenthood (as defined by experts); the approval process from the viewpoints of social workers and applicants; and adoption's link to citizenship, and its use as a metaphor for belonging.

Adopting a Foucaultian perspective, Perreau calls the biopolitics of adoption “pastoral”: it manages the individual for the good of the collective “flock”; it considers itself outside politics; and it considers not so much the real behavior of individuals as an allegorical representation of them. His argument sheds new light on American debates on bioethics, identity, and citizenship.

A nuanced discussion of human enhancement that argues for enhancement that does not significantly exceed what is currently possible for human beings.

The transformative potential of genetic and cybernetic technologies to enhance human capabilities is most often either rejected on moral and prudential grounds or hailed as the future salvation of humanity. In this book, Nicholas Agar offers a more nuanced view, making a case for moderate human enhancement—improvements to attributes and abilities that do not significantly exceed what is currently possible for human beings. He argues against radical human enhancement, or improvements that greatly exceed current human capabilities.

Agar explores notions of transformative change and motives for human enhancement; distinguishes between the instrumental and intrinsic value of enhancements; argues that too much enhancement undermines human identity; considers the possibility of cognitively enhanced scientists; and argues against radical life extension. Making the case for moderate enhancement, Agar argues that many objections to enhancement are better understood as directed at the degree of enhancement rather than enhancement itself. Moderate human enhancement meets the requirement of truly human enhancement. By radically enhancing human cognitive capabilities, by contrast, we may inadvertently create beings (“post-persons”) with moral status higher than that of persons. If we create beings more entitled to benefits and protections against harms than persons, Agar writes, this will be bad news for the unenhanced. Moderate human enhancement offers a more appealing vision of the future and of our relationship to technology.

An argument that modern liberal democracies should tolerate human enhancement technologies, answering key objections by critics of these practices.

Emerging biotechnologies that manipulate human genetic material have drawn a chorus of objections from politicians, pundits, and scholars. In Humanity Enhanced, Russell Blackford eschews the heated rhetoric that surrounds genetic enhancement technologies to examine them in the context of liberal thought, discussing the public policy issues they raise from legal and political perspectives. Some see the possibility of genetic choice as challenging the values of liberal democracy. Blackford argues that the challenge is not, as commonly supposed, the urgent need for a strict regulatory action. Rather, the challenge is that fear of these technologies has created an atmosphere in which liberal tolerance itself is threatened.

Focusing on reproductive cloning, pre-implantation genetic diagnosis of embryos, and genetic engineering, Blackford takes on objections to enhancement technologies (raised by Jürgen Habermas and others) based on such concerns as individual autonomy and distributive justice. He argues that some enhancements would be genuinely beneficial, and that it would be justified in some circumstances even to exert pressure on parents to undertake genetic modification of embryos. Blackford argues against draconian suppression of human enhancement, although he acknowledges that some specific and limited regulation may be required in the future. More generally, he argues, liberal democracies would demonstrate liberal values by tolerating and accepting the emerging technologies of genetic choice.

An analysis of current biomedical research misconduct policy that proposes a new approach emphasizing the context of misconduct and improved oversight.

Federal regulations that govern research misconduct in biomedicine have not been able to prevent an ongoing series of high-profile cases of fabricating, falsifying, or plagiarizing scientific research. In this book, Barbara Redman looks critically at current research misconduct policy and proposes a new approach that emphasizes institutional context and improved oversight.

Current policy attempts to control risk at the individual level. But Redman argues that a fair and effective policy must reflect the context in which the behavior in question is embedded. As journalists who covered many research misconduct cases observed, the roots of fraud “lie in the barrel, not in the bad apples that occasionally roll into view.” Drawing on literature in related fields—including moral psychology, the policy sciences, the organizational sciences, and law—as well as analyses of misconduct cases, Redman considers research misconduct from various perspectives. She also examines in detail a series of clinical research cases in which repeated misconduct went undetected and finds laxity of oversight, little attention to harm done, and inadequate correction of the scientific record. Study questions enhance the book's value for graduate and professional courses in research ethics.

Redman argues that the goals of any research misconduct policy should be to protect scientific capital (knowledge, scientists, institutions, norms of science), support fair competition, contain harms to end users and to the public trust, and enable science to meet its societal obligations.

A range of views on the morality of synthetic biology and its place in public policy and political discourse.

Synthetic biology, which aims to design and build organisms that serve human needs, has potential applications that range from producing biofuels to programming human behavior. The emergence of this new form of biotechnology, however, raises a variety of ethical questions—first and foremost, whether synthetic biology is intrinsically troubling in moral terms. Is it an egregious example of scientists “playing God”? Synthetic Biology and Morality takes on this threshold ethical question, as well as others that follow, offering a range of philosophical and political perspectives on the power of synthetic biology.

The contributors consider the basic question of the ethics of making new organisms, with essays that lay out the conceptual terrain and offer opposing views of the intrinsic moral concerns; discuss the possibility that synthetic organisms are inherently valuable; and address whether, and how, moral objections to synthetic biology could be relevant to policy making and political discourse. Variations of these questions have been raised before, in debates over other biotechnologies, but, as this book shows, they take on novel and illuminating form when considered in the context of synthetic biology.

The political and policy implications of recent developments in neuroscience, including new techniques in imaging and neurogenetics.

New findings in neuroscience have given us unprecedented knowledge about the workings of the brain. Innovative research—much of it based on neuroimaging results—suggests not only treatments for neural disorders but also the possibility of increasingly precise and effective ways to predict, modify, and control behavior. In this book, Robert Blank examines the complex ethical and policy issues raised by our new capabilities of intervention in the brain.

After surveying current knowledge about the brain and describing a wide range of experimental and clinical interventions—from behavior-modifying drugs to neural implants to virtual reality—Blank discusses the political and philosophical implications of these scientific advances. If human individuality is simply a product of a network of manipulable nerve cell connections, and if aggressive behavior is a treatable biochemical condition, what happens to our conceptions of individual responsibility, autonomy, and free will? In light of new neuroscientific possibilities, Blank considers such topics as informed consent, addiction, criminal justice, racism, commercial and military applications of neuroscience research, new ways to define death, and political ideology and partisanship.

Our political and social institutions have not kept pace with the rapid advances in neuroscience. This book shows why the political issues surrounding the application of this new research should be debated before interventions in the brain become routine.

One of the founding fathers of bioethics describes the development of the field and his thinking on some of the crucial issues of our time.

Daniel Callahan helped invent the field of bioethics more than forty years ago when he decided to use his training in philosophy to grapple with ethical problems in biology and medicine. Disenchanted with academic philosophy because of its analytical bent and distance from the concerns of real life, Callahan found the ethical issues raised by the rapid medical advances of the 1960s—which included the birth control pill, heart transplants, and new capacities to keep very sick people alive—to be philosophical questions with immediate real-world relevance. In this memoir, Callahan describes his part in the founding of bioethics and traces his thinking on critical issues including embryonic stem cell research, market-driven health care, and medical rationing. He identifies the major challenges facing bioethics today and ruminates on its future.

Callahan writes about founding the Hastings Center—the first bioethics research institution—with the author and psychiatrist Willard Gaylin in 1969, and recounts the challenges of running a think tank while keeping up a prolific flow of influential books and articles. Editor of the famous liberal Catholic magazine Commonweal in the 1960s, Callahan describes his now-secular approach to issues of illness and mortality. He questions the idea of endless medical “progress” and interventionist end-of-life care that seems to blur the boundary between living and dying. It is the role of bioethics, he argues, to be a loyal dissenter in the onward march of medical progress. The most important challenge for bioethics now is to help rethink the very goals of medicine.

A critical review of the debate over the still-hypothetical possibility of prenatal intervention by parents to select the sexual orientation of their children.

Parents routinely turn to prenatal testing to screen for genetic or chromosomal disorders or to learn their child's sex. What if they could use similar prenatal interventions to learn (or change) their child's sexual orientation? Bioethicists have debated the moral implications of this still-hypothetical possibility for several decades. Some commentators fear that any scientific efforts to understand the origins of homosexuality could mean the end of gay and lesbian people, if parents shy away from having homosexual children. Others defend parents' rights to choose the traits of their children in general and see no reason to treat sexual orientation differently. In this book, Timothy Murphy traces the controversy over prenatal selection of sexual orientation, offering a critical review of the literature and presenting his own argument in favor of parents' reproductive liberty.

Arguing against commentators who want to restrict the scientific study of sexual orientation or technologies that emerge from that study, Murphy proposes a defense of parents' right to choose. This, he argues, is the only view that helps protect children from hurtful family environments, that is consistent with the increasing powers of prenatal interventions, and that respects human futures as something other than accidents of the genetic lottery.

A novel and multidisciplinary exposition and theorization of human dignity and rights, brought to bear on current issues in bioethics and biolaw.

“Human dignity” has been enshrined in international agreements and national constitutions as a fundamental human right. The World Medical Association calls on physicians to respect human dignity and to discharge their duties with dignity. And yet human dignity is a term—like love, hope, and justice—that is intuitively grasped but never clearly defined. Some ethicists and bioethicists dismiss it; other thinkers point to its use in the service of particular ideologies. In this book, Michael Barilan offers an urgently needed, nonideological, and thorough conceptual clarification of human dignity and human rights, relating these ideas to current issues in ethics, law, and bioethics.

Combining social history, history of ideas, moral theology, applied ethics, and political theory, Barilan tells the story of human dignity as a background moral ethos to human rights. After setting the problem in its scholarly context, he offers a hermeneutics of the formative texts on Imago Dei; provides a philosophical explication of the value of human dignity and of vulnerability; presents a comprehensive theory of human rights from a natural, humanist perspective; explores issues of moral status; and examines the value of responsibility as a link between virtue ethics and human dignity and rights.

Barilan accompanies his theoretical claim with numerous practical illustrations, linking his theory to such issues in bioethics as end-of-life care, cloning, abortion, torture, treatment of the mentally incapacitated, the right to health care, the human organ market, disability and notions of difference, and privacy, highlighting many relevant legal aspects in constitutional and humanitarian law.

An argument against the “lifeboat ethic” of contemporary bioethics that views medicine as a commodity rather than a tradition of care and caring.

Bioethics emerged in the 1960s from a conviction that physicians and researchers needed the guidance of philosophers in handling the issues raised by technological advances in medicine. It blossomed as a response to the perceived doctor-knows-best paternalism of the traditional medical ethic and today plays a critical role in health policies and treatment decisions. Bioethics claimed to offer a set of generally applicable, universally accepted guidelines that would simplify complex situations. In Thieves of Virtue, Tom Koch contends that bioethics has failed to deliver on its promises. Instead, he argues, bioethics has promoted a view of medicine as a commodity whose delivery is predicated not on care but on economic efficiency.

At the heart of bioethics, Koch writes, is a “lifeboat ethic” that assumes “scarcity” of medical resources is a natural condition rather than the result of prior economic, political, and social choices. The idea of natural scarcity requiring ethical triage signaled a shift in ethical emphasis from patient care and the physician's responsibility for it to neoliberal accountancies and the promotion of research as the preeminent good.

The solution to the failure of bioethics is not a new set of simplistic principles. Koch points the way to a transformed medical ethics that is humanist, responsible, and defensible.

A balanced, accessible discussion of whether and on what grounds animal research can be ethically justified.

An estimated 100 million nonhuman vertebrates worldwide—including primates, dogs, cats, rabbits, hamsters, birds, rats, and mice—are bred, captured, or otherwise acquired every year for research purposes. Much of this research is seriously detrimental to the welfare of these animals, causing pain, distress, injury, or death. This book explores the ethical controversies that have arisen over animal research, examining closely the complex scientific, philosophical, moral, and legal issues involved.

Defenders of animal research face a twofold challenge: they must make a compelling case for the unique benefits offered by animal research; and they must provide a rationale for why these benefits justify treating animal subjects in ways that would be unacceptable for human subjects. This challenge is at the heart of the book. Some contributors argue that it can be met fairly easily; others argue that it can never be met; still others argue that it can sometimes be met, although not necessarily easily. Their essays consider how moral theory can be brought to bear on the practical ethical questions raised by animal research, examine the new challenges raised by the emerging possibilities of biotechnology, and consider how to achieve a more productive dialogue on this polarizing subject. The book's careful blending of theoretical and practical considerations and its balanced arguments make it valuable for instructors as well as for scholars and practitioners.

A wide-ranging exploration of whether or not choosing to procreate can be morally justified—and if so, how.

In contemporary Western society, people are more often called upon to justify the choice not to have children than they are to supply reasons for having them. In this book, Christine Overall maintains that the burden of proof should be reversed: that the choice to have children calls for more careful justification and reasoning than the choice not to. Arguing that the choice to have children is not just a prudential or pragmatic decision but one with ethical repercussions, Overall offers a wide-ranging exploration of how we might think systematically and deeply about this fundamental aspect of human life. Writing from a feminist perspective, she also acknowledges the inevitably gendered nature of the decision; the choice has different meanings, implications, and risks for women than it has for men.

After considering a series of ethical approaches to procreation, and finding them inadequate or incomplete, Overall offers instead a novel argument. Exploring the nature of the biological parent-child relationship—which is not only genetic but also psychological, physical, intellectual, and moral—she argues that the formation of that relationship is the best possible reason for choosing to have a child.

Investigations into the interplay of biological and legal conceptions of life, from government policies on cloning to DNA profiling by law enforcement.

Legal texts have been with us since the dawn of human history. Beginning in 1953, life too became textual. The discovery of the structure of DNA made it possible to represent the basic matter of life with permutations and combinations of four letters of the alphabet, A, T, C, and G. Since then, the biological and legal conceptions of life have been in constant, mutually constitutive interplay—the former focusing on life's definition, the latter on life's entitlements. Reframing Rights argues that this period of transformative change in law and the life sciences should be considered “bioconstitutional.”

Reframing Rights explores the evolving relationship of biology, biotechnology, and law through a series of national and cross-national case studies. Sheila Jasanoff maps out the conceptual territory in a substantive editorial introduction, after which the contributors offer “snapshots” of developments at the frontiers of biotechnology and the law. Chapters examine such topics as national cloning and xenotransplant policies; the politics of stem cell research in Britain, Germany, and Italy; DNA profiling and DNA databases in criminal law; clinical trials in India and the United States; the GM crop controversy in Britain; and precautionary policymaking in the European Union. These cases demonstrate changes of constitutional significance in the relations among human bodies, selves, science, and the state.

Explores the ethical, legal, and societal issues arising from brain imaging, psychopharmacology, and other new developments in neuroscience.

Neuroscience increasingly allows us to explain, predict, and even control aspects of human behavior. The ethical issues that arise from these developments extend beyond the boundaries of conventional bioethics into philosophy of mind, psychology, theology, public policy, and the law. This broader set of concerns is the subject matter of neuroethics. In this book, leading neuroscientist Martha Farah introduces the reader to the key issues of neuroethics, placing them in scientific and cultural context and presenting a carefully chosen set of essays, articles, and excerpts from longer works that explore specific problems in neuroethics from the perspectives of a diverse set of authors. Included are writings by such leading scientists, philosophers, and legal scholars as Carl Elliot, Joshua Greene, Steven Hyman, Peter Kramer, and Elizabeth Phelps. Topics include the ethical dilemmas of cognitive enhancement; issues of personality, memory and identity; the ability of brain imaging to both persuade and reveal; the legal implications of neuroscience; and the many ways in which neuroscience challenges our conception of what it means to be a person.

Neuroethics is an essential guide to the most intellectually challenging and socially significant issues at the interface of neuroscience and society. Farah's clear writing and well-chosen readings will be appreciated by scientist and humanist alike, and the inclusion of questions for discussion in each section makes the book suitable for classroom use.

A survey of the emerging field of neuroethics that calls for a multidisciplinary, pragmatic approach for tackling key issues and improving patient care.

Today the measurable health burden of neurological and mental health disorders matches or even surpasses any other cluster of health conditions. At the same time, the clinical applications of recent advances in neuroscience are hardly straightforward. In Pragmatic Neuroethics, Eric Racine argues that the emerging field of neuroethics offers a way to integrate such specialties as neurology, psychiatry, and neurosurgery with the humanities and social sciences, neuroscience research, and related healthcare professions, with the goal of tackling key ethical challenges and improving patient care. Racine provides a survey of the often diverging perspectives within neuroethics, offers a theoretical framework supported by empirical data, and discusses the neuroethical implications of such issues as media coverage of neuroscience innovation and the importance of public concerns and lay opinion; nonmedical use of pharmaceuticals for performance enhancement; and the discord between intuitive notions about consciousness and behavior and the scientific understanding of them.

Racine proposes a pragmatic neuroethics that combines pluralistic approaches, bottom-up research perspectives, and a focus on practical issues (in contrast to other more theoretical and single-discipline approaches to the field). [He discusses ethical issues related to powerful neuroscience insights into the mechanisms underlying moral reasoning, cooperative behavior, and such emotional processes as empathy.] In addition, he outlines a pragmatic framework for neuroethics, based on the philosophy of emergentism, which identifies conditions for the meaningful contribution of neuroscience to ethics, and sketches new directions and strategies for meeting future challenges for neuroscience and society.

Leading scholars debate politically progressive perspectives on bioethics and the implications for society, politics, and science in the twenty-first century.

Bioethics has become increasingly politicized over the past decade. Conservative voices dominated the debate at first, but the recent resurgence of progressivism and the application of its fundamental values (social justice, critical optimism, practical problem solving) to bioethical issues have helped correct this ideological imbalance. Progress in Bioethics is the first book to debate the meaning of progressive bioethics and to offer perspectives on the topic both from bioethicists who consider themselves progressive and from bioethicists who do not. It aims to begin a dialogue and to provide a foothold for readers interested in understanding the field.

The chapter authors, leading scholars in the field, discuss the meaning of progressive bioethics, the rise of conservative bioethics, the progressive stance toward biotechnology, the interplay of progressive bioethics and religion, and progressive approaches to such specific policy issues as bioethics commissions, stem cell research, and health-care reform.

Experts explore the potential benefits, risks, and moral aspects of protocell technology, which creates simple forms of life from nonliving material.

Teams of scientists around the world are racing to create protocells—microscopic, self-organizing entities that spontaneously assemble from simple organic and inorganic materials. The creation of fully autonomous protocells—a technology that can, for all intents and purposes, be considered literally alive—is only a matter of time. This book examines the pressing social and ethical issues raised by the creation of life in the laboratory. Protocells might offer great medical and social benefits and vast new economic opportunities, but they also pose potential risks and threaten cultural and moral norms against tampering with nature and “playing God.” The Ethics of Protocells offers a variety of perspectives on these concerns. After a brief survey of current protocell research (including the much-publicized “top-down” strategy of J. Craig Venter and Hamilton Smith, for which they have received multimillion dollar financing from the U.S. Department of Energy), the chapters treat risk, uncertainty, and precaution; lessons from recent history and related technologies; and ethics in a future society with protocells. The discussions range from new considerations of the precautionary principle and the role of professional ethicists to explorations of what can be learned from society's experience with other biotechnologies and the open-source software movement.

A balanced proposal that protects both a patient's access to care and a physician's ability to refuse to provide certain services for reasons of conscience.

Physicians in the United States who refuse to perform a variety of legally permissible medical services because of their own moral objections are often protected by “conscience clauses.” These laws, on the books in nearly every state since the legalization of abortion by Roe v. Wade, shield physicians and other health professionals from such potential consequences of refusal as liability and dismissal. While some praise conscience clauses as protecting important freedoms, opponents, concerned with patient access to care, argue that professional refusals should be tolerated only when they are based on valid medical grounds. In Conflicts of Conscience in Health Care, Holly Fernandez Lynch finds a way around the polarizing rhetoric associated with this issue by proposing a compromise that protects both a patient's access to care and a physician's ability to refuse. This focus on compromise is crucial, as new uses of medical technology expand the controversy beyond abortion and contraception to reach an increasing number of doctors and patients. Lynch argues that doctor-patient matching on the basis of personal moral values would eliminate, or at least minimize, many conflicts of conscience, and suggests that state licensing boards facilitate this goal. Licensing boards would be responsible for balancing the interests of doctors and patients by ensuring a sufficient number of willing physicians such that no physician's refusal leaves a patient entirely without access to desired medical services. This proposed solution, Lynch argues, accommodates patients' freedoms while leaving important room in the profession for individuals who find some of the capabilities of medical technology to be ethically objectionable.

Scholars discuss the genetic modification of embryonic cells from the viewpoints of traditional Jewish and Christian teaching, considering both the possible therapeutic benefits of this technology and moral concerns about its implementation.

We are approaching the day when advances in biotechnology will allow parents to “design” a baby with the traits they want. The continuing debate over the possibilities of genetic engineering has been spirited, but so far largely confined to the realms of bioethics and public policy. Design and Destiny approaches the question in religious terms, discussing human germline modification (the genetic modification of the embryonic cells that become the eggs or sperm of a developing organism) from the viewpoints of traditional Christian and Jewish teaching. The contributors, leading religious scholars and writers, call our attention not to technology but to humanity, reflecting upon the meaning and destiny of human life in a technological age. Many of these scholars argue that religious teaching can support human germline modification implemented for therapeutic reasons, although they offer certain moral conditions that must be met.

The essays offer a surprising variety of opinions, including a discussion of Judaism's traditional presumption in favor of medicine, an argument that Catholic doctrine could accept germline modification if it is therapeutic for the embryo, an argument implying that “traditional” Christian teaching permits germline modification whether for therapy or enhancement, and a “classical” Protestant view that germline modification should be categorically opposed.

An ethnographic study of fetoscopy that considers both the broader cultural context of this high-risk obstetrical procedure and the patient's individual experience.

In Looking Within, Deborah Blizzard examines the high-risk in utero surgery known as fetoscopy, considering it as both cutting-edge medical technology and as a sociocultural construction of patients, their social networks, and medical providers. She looks at the way individual experiences shape these procedures and how fetoscopy affects individuals (both patients and providers) on a personal, emotional level. Based on an eleven-month ethnographic study of the fetoscopy practice at a community-based hospital and further interviews with former patients, Looking Within offers a vivid picture of the sometimes conflicted, often desperate, and always emotional lives of those undergoing fetoscopy, and challenges current assumptions about normal and appropriate pregnancy experiences. To convey the complex reality of fetoscopy, Blizzard draws from the experiences of the real patients she interviewed for the book to present the fictional case of Melinda and Joe, taking them through the entire process, from diagnosis to decision to outcome. She then discusses the emergence of fetoscopy as an accepted form of high-risk obstetrical care, how fetoscopy programs are established at hospitals, and why otherwise healthy women consent to surgery. Blizzard examines the use of fetoscopy in single-fetus and in twin pregnancies, looking at how religion, culture, society, and medical science inform any understanding of who or what is in utero (a baby? a tumor? a mass?). She also discusses definitions of loss and success, and the narratives patients and their social networks construct to make sense of them. Looking Within will help physicians and nurses improve the development and delivery of fetoscopy procedures, help patients understand this new technology, and help scholars evaluate fetoscopy's bioethical, social, and cultural implications.

In recent years, advances in biological science and technology have outpaced policymakers' attempts to deal with them. Current Controversies in the Biological Sciences examines the ways in which the federal government uses scientific information in reaching policy decisions, providing case studies of the interactions between science and government on different biomedical, biological, and environmental issues. These case studies document a broad range of complex issues in science policy—from the Human Genome Project to tobacco regulation—and provide an accessible overview of both the science behind the issues and the policy-making process. The cases illustrate the different ways in which science and politics intersect in policy decisions, as well as the different forms policy itself may take—including not only regulatory action but the lack of regulation. Among the topics examined are public and private research funding, as seen in gene patenting; reluctance to regulate even when a product has been proven unhealthy, as in the case of tobacco; a comparison of U.S. and international policy responses to genetically modified organisms; and the competing interests at play in air pollution policy. Each chapter includes shorter side essays on related topics (for example, essays on issues raised by the SARS epidemic accompany the detailed case study of the public health response to the anthrax-laced mail received in the weeks after 9/11). This clear and readable introduction to controversial issues in the biological sciences will be a valuable resource for students of science policy and bioethics and for professionals in industry, government, and nongovernmental organizations who need background on emerging issues in the biological sciences.

Is medical ethics in times of armed conflict identical to medical ethics in times of peace, as the World Medical Association declares? In Bioethics and Armed Conflict, the first comprehensive study of medical ethics in conventional, unconventional, and low-intensity war, Michael Gross examines the dilemmas that arise when bioethical principles clash with military necessity—when physicians try to save lives during an endeavor dedicated to taking them—and describes both the conflicts and congruencies of military and medical ethics.

Gross describes how the principles of contemporary just war, unlike those of medical ethics, often go beyond the welfare of the individual to consider the collective interests of combatants and noncombatants and the general interests of the state. Military necessity plays havoc with such patients' rights as the right to life, the right to medical care, informed consent, confidentiality, and the right to die. The principles of triage in battle conditions dictate not need-based treatment but the distribution of resources that will return the greatest number of soldiers to active duty. And unconventional warfare, including current "wars" on terrorism, challenges the traditional concept of medical neutrality as physicians who have sworn to "do no harm" are called upon to lend their expertise to "interrogational" torture or to the development of biological or chemical weapons. Difficult dilemmas inevitably arise during armed conflict, and medicine, Gross concludes, is not above the fray. Medical ethics in time of war cannot be identical to medical ethics in peacetime.

A new patient-centered approach to psychiatry that aims to resolve the field's conceptual tension between science and humanism by drawing on classical American pragmatism and contemporary pragmatic bioethics.

Psychiatry today is torn by opposing sensibilities. Is it primarily a science of brain functioning or primarily an art of understanding the human mind in its social and cultural context? Competing conceptions of mental illness as amenable to scientific explanation or as deeply complex and beyond the reach of empirical study have left the field conceptually divided between science and humanism. In Healing Psychiatry David Brendel takes a novel approach to this stubborn problem. Drawing on the classical American pragmatism of Charles Sanders Peirce, William James, and John Dewey, as well as contemporary work of pragmatic bioethicists, Brendel proposes a "clinical pragmatism" that synthesizes scientific and humanistic approaches to mental health care. Psychiatry, he argues, must integrate scientific and humanistic models by emphasizing the practical, pluralistic, participatory, and provisional aspects of clinical diagnosis and treatment. Psychiatrists need to have the skill and flexibility to use scientific and humanistic approaches in a collaborative, open-ended clinical process; they must recognize the complexity of human suffering even as they strive for scientific rigor. This is the only way, he writes, that psychiatry can heal its conceptual rift and the emotional wounds of its patients.

Healing Psychiatry explores these issues from both clinical and theoretical standpoints and uses case histories to support its basic argument. Brendel calls for an open-minded and flexible yet scientifically informed approach to understanding, diagnosing, and treating mental disorders. And he considers the future of psychiatry, applying the principles of clinical pragmatism to a broad range of ethical concerns in psychiatric training and research.

Argues that applied bioethics should embrace utilitarian decision analysis, thus avoiding recommendations expected to do more harm than good.

Governments, health professionals, patients, research institutions, and research subjects look to bioethicists for guidance in making important decisions about medical treatment and research. And yet, argues Jonathan Baron in Against Bioethics, applied bioethics lacks the authority of a coherent guiding theory and is based largely on intuitive judgments. Baron proposes an alternative, arguing that bioethics could have a coherent theory based on utilitarianism and decision analysis. Utilitarianism holds that the best option is the one that does the most expected good. Decision analysis provides a way of thinking about the risks and trade-offs of specific options. Like economics, utilitarian decision analysis makes predictions of expected good in complex situations, using data when possible, and focusing human judgment on the issues relevant to consequences. With such a guiding theory, bioethics would never yield decisions that clearly go against the expected good of those involved, as some do now.

Baron discusses issues in bioethics that can be illuminated by such analysis, including "enhancements" to nature in the form of genetics, drugs, and mind control; reproduction; death and end-of-life issues, including advance directives, euthanasia, and organ donation; coercion and consent; conflict of interest and the reform of internal review boards; and drug research. Although Baron opposes current practice in bioethics, he argues that by combining utilitarianism and decision analysis, bioethics can achieve its aims of providing authoritative guidance in resolving thorny medical and ethical issues.

The principle of patient autonomy dominates the contemporary debate over medical ethics. In this examination of the doctor-patient relationship, physician and philosopher Alfred Tauber argues that the idea of patient autonomy—which was inspired by other rights-based movements of the 1960s—was an extrapolation from political and social philosophy that fails to ground medicine's moral philosophy. He proposes instead a reconfiguration of personal autonomy and a renewed commitment to an ethics of care. In this formulation, physician beneficence and responsibility become powerful means for supporting the autonomy and dignity of patients. Beneficence, Tauber argues, should not be confused with the medical paternalism that fueled the patient rights movement. Rather, beneficence and responsibility are moral principles that not only are compatible with patient autonomy but strengthen it. Coordinating the rights of patients with the responsibilities of their caregivers will result in a more humane and robust medicine.

Tauber examines the historical and philosophical competition between facts (scientific objectivity) and values (patient care) in medicine. He analyzes the shifting conceptions of personhood underlying the doctor-patient relationship, offers a "topology" of autonomy, from Locke and Kant to Hume and Mill, and explores both philosophical and practical strategies for reconfiguring trust and autonomy. Framing the practicalities of the clinical encounter with moral reflections, Tauber calls for an ethical medicine in which facts and values are integrated and humane values are deliberately included in the program of care.

The provocative contention of the postmodernist and feminist essays in Ethics of the Body is that conventional bioethics is out of touch, despite its growing profile. It is out of touch with an ongoing phenomenological sense of bodies themselves; with the impact of postmodernist theory as it problematizes the certainties of binary thinking; and with a postmodern culture in which bioscientific developments force us to question what is meant by the notion of the human self. The authors demonstrate that the conventional normative framework of bioethics is called into question by issues as wide ranging as genetic manipulation, disability, high-tech prosthetics, and intersexuality. The essays show how both the theory and practice of bioethics can benefit from postmodernism's characteristic fluidity and multiplicity, as well as from the insights of a reconceived feminist bioethics. They address issues in philosophy, law, bioscientific research, psychiatry, cultural studies, and feminism from a "postconventional" perspective that looks beyond the familiar ideas of the body, proposing not a bioethics about the body but a radical ethics of the body.

After exploring notions of difference in both feminist and postmodernist terms, the book considers specific issues—including HIV, addiction, borderline personality disorder, and cancer—that challenge the principles of conventional bioethics. The focus then turns to questions raised by biotechnology: one essay rethinks the traditional feminist ethics of care in the context of new reproductive technology, while others tackle genetic and genomic issues. Finally, the book looks at embodiment and some specifically anomalous forms of being-in-the-body, including a consideration of intersex infants and children that draws on feminist, postructuralist, and queer theory.

A legal and moral analysis of medical decision making on behalf of those with such severe cognitive impairments that they cannot exercise self-determination.

In this book, Norman Cantor analyzes the legal and moral status of people with profound mental disabilities—those with extreme cognitive impairments that prevent their exercise of medical self-determination. He proposes a legal and moral framework for surrogate medical decision making on their behalf. The issues Cantor explores will be of interest to professionals in law, medicine, psychology, philosophy, and ethics, as well as to parents, guardians, and health care providers who face perplexing issues in the context of surrogate medical decision making.

The profoundly mentally disabled are thought by some moral philosophers to lack the minimum cognitive ability for personhood. Countering this position, Cantor advances both theoretical and practical arguments for according them full legal and moral status. He also argues that the concept of intrinsic human dignity should have an integral role in shaping the bounds of surrogate decision making. Thus, he claims, while profoundly mentally disabled persons are not entitled to make their own medical decisions, respect for intrinsic human dignity dictates their right to have a conscientious surrogate make medical decisions on their behalf. Cantor discusses the criteria that bind such surrogates. He asserts, contrary to popular wisdom, that the best interests of the disabled person are not always the determinative standard: the interests of family or others can sometimes be considered. Surrogates may even, consistent with the intrinsic human dignity standard, sometimes authorize tissue donation or participation in nontherapeutic medical research by profoundly disabled persons. Intrinsic human dignity limits the occasions for such decisions and dictates close attention to the preferences and feelings of the profoundly disabled persons themselves. Cantor also analyzes the underlying philosophical rationale that makes these decision-making criteria consistent with law and morals.

This examination of end-of-life decision making offers a broader perspective than that found in the extensive existing literature on this topic by offering a cross-national comparison. Experts from twelve countries analyze death-related issues and policies in their respective nations, discussing such topics as health care costs, advance directives or wills, pain management, and cultural, social, and religious factors. The countries selected for study—Brazil, China, Germany, India, Israel, Japan, Kenya, the Netherlands, Taiwan, Turkey, the United Kingdom, and the United States—represent a mix of East and West, developed and developing nations seldom considered together in analyses of these issues. This is the first systematic attempt to analyze end-of-life issues in many of these countries; the chapters on China, Kenya (of special significance because of the HIV/AIDS epidemic in sub-Saharan Africa) and Turkey break new ground.

Each author reports on various factors in end-of-life decisions: estimated costs of dying, including health care costs; the proportion of deaths occurring in hospitals, in hospices, and at home; the prevalence and variety of advance directives; the mix of high technology and palliative care; the cut-off point for aggressive care and the legal definition of death; government policies on end-of-life decisions, assisted suicide, and euthanasia; and cultural, social, and religious influences. The findings show that there are great differences among countries even in the way these issues are framed. Scholars, policymakers, and medical practitioners can all benefit from the extensive information in these essays on how different nations are dealing with death-related issues.

Is DNA technology the ultimate diviner of guilt or the ultimate threat to civil liberties? Over the past decade, DNA has been used to exonerate hundreds and to convict thousands. Its expanded use over the coming decade promises to recalibrate significantly the balance between collective security and individual freedom. For example, it is possible that law enforcement DNA databases will expand to include millions of individuals not convicted of any crime. Moreover, depending on what rules govern access, such databases could also be used for purposes that range from determining paternity to assessing predispositions to certain diseases or behaviors. Thus the use of DNA technology will involve tough trade-offs between individual and societal interests.

This book, written by a distinguished group of authors including U.S. Supreme Court Justice Stephen Breyer, explores the ethical, procedural, and economic challenges posed by the use of DNA evidence as well as future directions for the technology. After laying the conceptual historical, legal, and scientific groundwork for the debate, the book considers bioethical issues raised by the collection of DNA, including the question of control over DNA databases. The authors then turn to the possible genetic bases of human behavior and the implications of this still-unresolved issue for the criminal justice system. Finally, the book examines the current debate over the many roles that DNA can and should play in criminal justice.

As our scientific and technical abilities expand at breathtaking speeds, concern that modern genetics and bioengineering are leading us to a posthuman future is growing. Is Human Nature Obsolete? poses the overarching question of what it is to be human against the background of these current advances in biotechnology. Its perspective is philosophical and interdisciplinary rather than technical; the focus is on questions of fundamental ontological importance rather than the specifics of medical or scientific practice.

The authors—all distinguished scholars in their fields—take on questions about technology's goals and values that are often ignored or sidelined in the face of rapid scientific advances and the highly specialized nature of technical knowledge. The essays included represent a rich variety of thought, ranging from finely nuanced philosophical and theological arguments to historical studies and cultural commentaries. Several explore the historical background of today's biotechnology: Timothy Casey traces such developments as the emergence of cybernetic humanity from Cartesian dualism, and Diane Paul presents the history of "positive" versus coerced eugenics. Jean Bethke Elshtain discusses cloning as a "messianic project" to perfect the body and exclude natural diversity—giving as an example the elimination of Down Syndrome as an acceptable human type—while Harold Baillie calls for an examination of the metaphysical roots of personhood. Robert Proctor finds no evidence in paleontology for any "essence of humanity," and Tom Shannon argues against materialist reductionism. Addressing social concerns, Lisa Sowle Cahill finds the possibility of a political solution to the problems raised by genetic engineering in Catholic teachings on social justice, and Langdon Winner looks critically at the "scientific enthusiasts of a posthuman future." Taken as a whole, the book provides a humanistic overview of a subject too often considered only in its technological aspect.

Explores the philosophical and practical ethical implications of a definition of health as a state that allows us to reach our goals.

Definitions of health and disease are of more than theoretical interest. Understanding what it means to be healthy has implications for choices in medical treatment, for ethically sound informed consent, and for accurate assessment of policies or programs. This deeper understanding can help us create more effective public policy for health and medicine. It is notable that such contentious legal initiatives as the Americans with Disability Act and the Patients' Bill of Rights fail to define adequately the medical terms on which their effectiveness depends. In Ethics and the Metaphysics of Medicine, Kenneth Richman develops an "embedded instrumentalist" theory of health and applies it to practical problems in health care and medicine, addressing topics that range from the philosophy of science to knee surgery.

"Embedded instrumentalist" theories hold that health is a match between one's goals and one's ability to reach those goals, and that the relevant goals may vary from individual to individual. This captures the normative implications of the term health while avoiding problematic relativism. Richman's embedded instrumentalism differs from other theories of health in drawing a distinction between the health of individuals as biological organisms and the health of individuals as moral agents. This distinction illuminates many difficulties in patient-provider communication and helps us understand conflicts between promoting health and promoting ethically permissible behavior. After exploring, expanding, and defending this theory in the first part of the book, Richman examines its ethical implications, discussing such concerns as the connection between medical beneficence and respect for autonomy, patient-provider communication, living wills, and clinical education.

Experts discuss the economic, legal, and social issues surrounding the use of genetic testing in determining eligibility for life insurance.

Insurance companies routinely use an individual's medical history and family medical history in determining eligibility for life insurance; this is part of the process of medical underwriting. Insurers have also long used genetic information, often derived from family history, in underwriting. But rapid advances in gene identification and genetic testing are changing the way we look at genetic information. Should the results of genetic testing (which might identify a predisposition toward disease not related to medical history) be available to life insurance medical underwriters? Few if any life insurers currently require genetic testing, but there are no laws or regulations prohibiting its use. Genetics and Life Insurance examines the complex economic, legal, and social issues surrounding the use of genetic information in life insurance underwriting. The contributors are legal scholars, representatives of the life insurance industry (including an actuary and an insurance physician), a geneticist, a genetic counselor, a philosopher, and a consumer advocate. They explore all aspects of an issue that has only recently drawn the attention of policymakers and the public.

The book opens with a report on the results of a public opinion poll on genetics and life insurance. Succeeding chapters present the insurer perspective, a discussion of the economics of risk selection in life insurance, background information on the process of underwriting, a scientific analysis of genetic risks and mortality rates, a philosophical discussion of fairness and genetic underwriting, the viewpoints of consumers and genetics counselors, a comparison of different international policy approaches to the issue, and a legal analysis of antitrust implications when insurers collaborate in setting standards for medical underwriting. In the final chapter the editor addresses various policy options, examining the pros and cons of each one and assessing their political feasibility.

This textbook for instruction in biomedical research ethics can also serve as a valuable reference for professionals in the field of bioethics. The 149 cases included in the book are grouped in nine chapters, each of which covers a key area of debate in the field. Some of the case studies are classics, including the famous cases of the Tuskegee Syphilis Study (in which subjects with syphilis were not given treatment) and the Willowbrook hepatitis studies (in which institutionalized subjects were intentionally exposed to hepatitis). Others focus on such current issues as human embryonic stem cell research, cloning by somatic nuclear transfer, and the design and function of institutional review boards. Each chapter begins with a brief introduction that places the issues raised in context; this is followed by a number of cases (each of which is no more than a few pages). Study questions meant to encourage further discussion follow each case. After an introductory discussion of the history and tenets of ethics in medical research, the book's chapters cover the topics of oversight and study design; informed consent; the selection of subjects; conflicts of interest; the social effects of research; embryos, fetuses, and children; genetic research; the use of animals; and authorship and publication. Following these chapters are appendixes with the texts of the Nuremburg Code and the World Declaration of Geneva, two key documents in the establishment of bioethical standards for research. Also included are a glossary, a table of cases by general category, and an alphabetical listing of cases.

Modern scientific and medical advances bring new complexity and urgency to ethical issues in health care and biomedical research. This book applies the American philosophical theory of pragmatism to such bioethics. Critics of pragmatism argue that it lacks a universal moral foundation. Yet it is this very lack of a metaphysical dividing line between facts and values that makes pragmatism such a rigorous and appropriate method for solving problems in bioethics. For pragmatism, ethics is a way of satisfying the complex demands of multiple individuals and groups in a contingent and changing world. Pragmatism also demands careful attention to the ways in which scientific advances change our values and ethics. The essays in this book present different approaches to pragmatism and different ways of applying pragmatism to scientific and medical matters. They use pragmatism to guide thinking about such timely topics as stem cell research, human cloning, genetic testing, human enhancement, and care for the poor and aging. This new edition contains three new chapters, on difficulties with applying pragmatism to law and bioethics, on helping people to die, and on embryonic stem cell research.

Timely and provocative essays on bioethical questions brought to the forefront by the bioterrorist threat.

The war on terrorism and the threat of chemical and biological weapons have brought a new urgency to already complex moral and bioethical questions. In the Wake of Terror presents thought-provoking essays on many of the troubling issues facing American society, written by experts from the fields of medicine, health care policy, law, political science, history, philosophy, and theology. One of the first potential casualties of catastrophic circumstances is civil liberties. In the past, medical experiments conducted for national security purposes have violated ethical standards, and this book questions whether current policy provides sufficient safeguards against further abuses. It also focuses on public health issues, offering contrasting views on the extent to which civil authorities should be allowed to restrict freedom of movement in the name of national security and debating whether aggressive public health interventions improve public confidence and cooperation or detract from them. A major area of concern is preparedness for future terrorist attacks. Chapters are devoted to ethical issues involved in the development, distribution, and rationing of vaccines and antidotes; resource allocation and medical triage; the moral duties of emergency health workers and other first responders; and the obligations of private entities such as managed care organizations and pharmaceutical companies.

Contributors also address the implications of terrorism for our health insurance system and the role of genetic advances in bioterrorism. Underlying all of these issues, the authors argue, is the need to maintain a spirit of social solidarity, which can in turn only be achieved if preparations are publicly acknowledged and generally regarded as both prudent and fair.

The idea of the gene has been a central organizing theme in contemporary biology, and the Human Genome project and biotechnological advances have put the gene in the media spotlight. In this book Lenny Moss reconstructs the history of the gene concept, placing it in the context of the perennial interplay between theories of preformationism and theories of epigenesis. He finds that there are not one, but two, fundamental—and fundamentally different—senses of "the gene" in scientific use—one the heir to preformationism and the other the heir to epigenesis. "Gene-P", the preformationist gene concept, serves as an instrumental predictor of phenotypic outcomes, while "Gene-D", the gene of epigenesis, is a developmental resource that specifies possible amino acid sequences for proteins. Moss argues that the popular idea that genes constitute blueprints for organisms is the result of an unwarranted conflation of these independently valid senses of the gene, and he analyzes the rhetorical basis of this conflation.

In the heart of the book, Moss uses the Gene-D/Gene-P distinction to examine the real basis of biological order and of the pathological loss of order in cancer. He provides a detailed analysis of the "order-from-order" role of cell membranes and compartmentalization and considers dynamic approaches to biological order such as that of Stuart Kauffman. He reviews the history of cancer research with an emphasis on the oncogene and tumor suppressor gene models and shows how these gene-centered strategies point back to the significance of higher level, multi-cellular organizational fields in the onset and progression of cancer. Finally, Moss draws on the findings of the Human Genome Project, biological modularity, and the growing interest in resynthesyzing theories of evolution and development to look beyond the "century of the gene" toward a rebirth of biological understanding.

Engendering International Health presents the work of leading researchers on gender equity in international health. Growing economic inequalities reinforce social injustices, stall health gains, and deny good health to many. In particular, deep-seated gender biases in health research and policy institutions combine with a lack of well-articulated and accessible evidence to downgrade the importance of gender perspectives in health. The book's central premise is that unless public health changes direction, it cannot effectively address the needs of those who are most marginalized, many of whom are women.

The book offers evidence and analysis for both low- and high-income countries, providing a gender and health analysis cross-cut by a concern for other markers of social inequity, such as class and race. It details approaches and agendas that incorporate, but go beyond, commonly acknowledged issues relating to women's health; and it brings gender and equity analysis into the heart of the debates that dominate international health policy.

A study of the importance of self-trust for women's autonomy in reproductive health.

The power of new medical technologies, the cultural authority of physicians, and the gendered power dynamics of many patient-physician relationships can all inhibit women's reproductive freedom. Often these factors interfere with women's ability to trust themselves to choose and act in ways that are consistent with their own goals and values. In this book Carolyn McLeod introduces to the reproductive ethics literature the idea that in reproductive health care women's self-trust can be undermined in ways that threaten their autonomy. Understanding the importance of self-trust for autonomy, McLeod argues, is crucial to understanding the limits on women's reproductive freedom.

McLeod brings feminist insights in philosophical moral psychology to reproductive ethics, and to health-care ethics more broadly. She identifies the social environments in which self-trust is formed and encouraged. She also shows how women's experiences of reproductive health care can enrich our understanding of self-trust and autonomy as philosophical concepts. The book's theoretical components are grounded in women's concrete experiences. The cases discussed, which involve miscarriage, infertility treatment, and prenatal diagnosis, show that what many women feel toward themselves in reproductive contexts is analogous to what we feel toward others when we trust or distrust them.

McLeod also discusses what health-care providers can do to minimize the barriers to women's self-trust in reproductive health care, and why they have a duty to do so as part of their larger duty to respect patient autonomy.

Human embryonic stem cells can divide indefinitely and have the potential to develop into many types of tissue. Research on these cells is essential to one of the most intriguing medical frontiers, regenerative medicine. It also raises a host of difficult ethical issues and has sparked great public interest and controversy.

This book offers a foundation for thinking about the many issues involved in human embryonic stem cell research. It considers questions about the nature of human life, the limits of intervention into human cells and tissues, and the meaning of our corporeal existence. The fact that stem cells may be derived from living embryos that are destroyed in the process or from aborted fetuses ties the discussion of stem cell research to the ongoing debates on abortion. In addition to these issues, the essays in the book touch on broader questions such as who should approve controversial research and what constitutes human dignity, respect, and justice. The book contains contributions from the Ethics Advisory Board of the Geron Coroporation; excerpts from expert testimony given before the National Bioethics Advisory Commission, which helped shape recent National Institutes of Health policy; and original analytical essays on the implications of this research.

In recent years, bioethicists have worked on government commissions, on ethics committees in hospitals and nursing homes, and as bedside consultants. Because ethical knowledge is based on experience within the field rather than on universal theoretical propositions, it is open to criticism for its lack of theoretical foundation. Once in the clinic, however, ethicists noted the extent to which medical practice itself combined the certitudes of science with craft forms of knowledge. In an effort to forge a middle path between pure science and applied medical and ethical knowledge, bioethicists turned to the work of classical philosophy, especially the theme of a practical wisdom that entails a variable knowledge of particulars. In this book contemporary bioethicists and scholars of ancient philosophy explore the import of classical ethics on such pressing bioethical concerns as managed care, euthanasia, suicide, and abortion. Although the contributors write within the limits of their own disciplines, through cross references and counterarguments they engage in fruitful dialogue.

Although managed health care is a hot topic, too few discussions focus on health care rationing—who lives and who dies, death versus dollars. In this book physician and bioethicist Peter A. Ubel argues that physicians, health insurance companies, managed care organizations, and governments need to consider the cost-effectiveness of many new health care technologies. In particular, they need to think about how best to ration health care. Ubel believes that standard medical training should provide physicians with the expertise to decide when to withhold health care from patients. He discusses the moral questions raised by this position, and by health care rationing in general. He incorporates ethical arguments about the appropriate role of cost-effectiveness analysis in health care rationing, empirical research about how the general public wants to ration care, and clinical insights based on his practice of general internal medicine. Straddling the fields of ethics, economics, research psychology, and clinical medicine, he moves the debate forward from whether to ration to how to ration. The discussion is enlivened by actual case studies.